Poorest won't benefit from health reform until 2015

Published: Friday, September 27, 2013 at 4:30 a.m.

Last Modified: Thursday, September 26, 2013 at 6:42 p.m.

Enrollment in health insurance exchanges as part of the Affordable Care Act begins Oct. 1, but the executive director of The Free Clinics doesn't expect any changes for the organization's low-income, uninsured patients until at least 2015.

The Rev. Judith Long told a group of 10 citizens during a “Lunch & Learn” program Wednesday that most uninsured clients of The Free Clinics won't have much cause to shop federal insurance marketplaces beginning Oct. 1 because out-of-pocket expenses will be too steep.

The Affordable Care Act caps the maximum premiums for Americans buying insurance based on income. For most Free Clinics patients, it means premiums cannot exceed 6.3 percent of their family's gross income, Long said.

Regulators delayed capping out-of-pocket expenses until 2015, she said, but are still fining those who don't opt to buy insurance from a private insurer or a government-sponsored exchange. That penalty is $95 per uninsured person, which goes up to $695 by 2016.

“So our patients are looking at $229 to $1,447 a year in premium costs with no maximum out-of-pocket expenses, versus perhaps a penalty of $95,” Long said. “Bottom line, we do not anticipate our patients will be able to purchase insurance. So we will still be here and we'll still need everyone's support.”

Long said those exempted from penalties include those who don't pay taxes because they're income is too low, those for whom the cheapest plan exceeds 8 percent of income, undocumented or incarcerated people and Native Americans.

Henderson County has about 13,700 people who are uninsured and low-income, or roughly 1 of every 4.5 residents. Many of them receive free-and-reduced school lunches and food stamps and defer medical care because they can't afford it, Long said.

That makes them likely to remain uninsured even after health care reform is fully implemented, she said. That could change slightly in 2015 when out-of-pocket expenses are capped for most clinic patients at $2,250 a year, but Long anticipates The Free Clinics still will not see a reduction in caseloads.

Since 2008, The Free Clinics has experienced a 303 percent increase in patient encounters, she said. In 2012-13, the clinic saw 8,884 patient visits, arranged 68 surgeries through coordination of services and made 158 referrals to specialists who provided free services.

The Free Clinics serves low-income residents who do not qualify for Medicare or Medicaid, but cannot afford insurance.

There are between 49 million and 50 million uninsured in America currently. Long said if every state had accepted Medicaid expansion, 92 percent of all residents would have access to care within four or five years. But state-by-state participation leaves 32 million people uncovered, she said.

“So all this hoopla and noise and Congress and everything, and less than half the people currently uninsured will be covered because the states with the largest percentage of uninsured are not expanding Medicaid — Texas, North Carolina, Florida,” she said.

Long said Henderson County is fortunate to have the strongest safety net for poor, uninsured residents in the state, crediting the collaboration of nonprofits such as The Free Clinics and Blue Ridge Community Health Services, county Department of Social Services case workers, local hospitals and physicians.

“We're not miracle workers, but you would be amazed what we've been able to get on behalf of patients who come through our doors who need care,” she said. “However, with reform and the lack of Medicaid (expansion), it's an incredibly destabilizing force that we don't know what the impact is going to be.”

The Free Clinics is sponsoring two more “Lunch & Learns” programs focused on the Affordable Care Act from 12-2 p.m. Wednesday, Oct. 30 and Nov. 20. Space is limited and reservations are required. Call Kathryn Killian at 697.8422 or kkillian@thefreeclinics.org for a spot.

<p>Enrollment in health insurance exchanges as part of the Affordable Care Act begins Oct. 1, but the executive director of The Free Clinics doesn't expect any changes for the organization's low-income, uninsured patients until at least 2015.</p><p>The Rev. Judith Long told a group of 10 citizens during a “Lunch & Learn” program Wednesday that most uninsured clients of The Free Clinics won't have much cause to shop federal insurance marketplaces beginning Oct. 1 because out-of-pocket expenses will be too steep.</p><p>The Affordable Care Act caps the maximum premiums for Americans buying insurance based on income. For most Free Clinics patients, it means premiums cannot exceed 6.3 percent of their family's gross income, Long said.</p><p>Regulators delayed capping out-of-pocket expenses until 2015, she said, but are still fining those who don't opt to buy insurance from a private insurer or a government-sponsored exchange. That penalty is $95 per uninsured person, which goes up to $695 by 2016.</p><p>“So our patients are looking at $229 to $1,447 a year in premium costs with no maximum out-of-pocket expenses, versus perhaps a penalty of $95,” Long said. “Bottom line, we do not anticipate our patients will be able to purchase insurance. So we will still be here and we'll still need everyone's support.”</p><p>Long said those exempted from penalties include those who don't pay taxes because they're income is too low, those for whom the cheapest plan exceeds 8 percent of income, undocumented or incarcerated people and Native Americans. </p><p>Henderson County has about 13,700 people who are uninsured and low-income, or roughly 1 of every 4.5 residents. Many of them receive free-and-reduced school lunches and food stamps and defer medical care because they can't afford it, Long said.</p><p>That makes them likely to remain uninsured even after health care reform is fully implemented, she said. That could change slightly in 2015 when out-of-pocket expenses are capped for most clinic patients at $2,250 a year, but Long anticipates The Free Clinics still will not see a reduction in caseloads.</p><p>Since 2008, The Free Clinics has experienced a 303 percent increase in patient encounters, she said. In 2012-13, the clinic saw 8,884 patient visits, arranged 68 surgeries through coordination of services and made 158 referrals to specialists who provided free services.</p><p>The Free Clinics serves low-income residents who do not qualify for Medicare or Medicaid, but cannot afford insurance.</p><p>There are between 49 million and 50 million uninsured in America currently. Long said if every state had accepted Medicaid expansion, 92 percent of all residents would have access to care within four or five years. But state-by-state participation leaves 32 million people uncovered, she said.</p><p>“So all this hoopla and noise and Congress and everything, and less than half the people currently uninsured will be covered because the states with the largest percentage of uninsured are not expanding Medicaid — Texas, North Carolina, Florida,” she said. </p><p>Long said Henderson County is fortunate to have the strongest safety net for poor, uninsured residents in the state, crediting the collaboration of nonprofits such as The Free Clinics and Blue Ridge Community Health Services, county Department of Social Services case workers, local hospitals and physicians.</p><p>“We're not miracle workers, but you would be amazed what we've been able to get on behalf of patients who come through our doors who need care,” she said. “However, with reform and the lack of Medicaid (expansion), it's an incredibly destabilizing force that we don't know what the impact is going to be.”</p><p>The Free Clinics is sponsoring two more “Lunch & Learns” programs focused on the Affordable Care Act from 12-2 p.m. Wednesday, Oct. 30 and Nov. 20. Space is limited and reservations are required. Call Kathryn Killian at 697.8422 or kkillian@thefreeclinics.org for a spot.</p>